With the increasing range of conditions currently amenable to endovascular therapies, the knowledge of periprocedural blood pressure management is essential for the neurointerventional surgeon. This review discusses the physiology of cerebral blood flow and blood pressure, monitoring options for neurointerventional patients, useful agents for blood pressure elevation and reduction and neuroanesthetic considerations during procedures with an emphasis on practical decision-making. Also included are parameters for conditions typically encountered in the neurointerventional suite based on best available evidence, with reference to blood pressure management before, during and after neurointerventional therapy.